Task Force Updates Recommendations on Follow-Up After Colonoscopy and Polypectomy

The US Multi-Society Task Force on Colorectal Cancer has released a consensus update to its 2012 recommendations for postcolonoscopy follow-up with or without polypectomy. Included in the update are a review of the available evidence on the impact of surveillance on colorectal cancer (CRC) incidence and mortality, recommendations for follow-up strategies, and a summary of the existing evidence’s key limitations.

“Recommendations for follow-up after normal colonoscopy among individuals age-eligible for screening, and post-polypectomy among all individuals with polyps are among the most common clinical scenarios requiring guidance,” according to the update’s authors.

The Task Force developed the update recommendations after new research has shaped a better understanding of CRC risk based on colonoscopy findings and patient characteristics, as well as after recent studies have revealed the potential impact that screening and surveillance colonoscopy has on outcomes such as incident CRC and polyps.

To develop the updated management recommendations, the authors identified articles relating to colonoscopy, polyps, and polypectomy surveillance that had been published in the PubMed, Embase, or Cumulative Index to Nursing and Allied Health Literature databases since January 1, 2012. 

Based on the new literature review—as well as prior findings—the authors developed several key updates for follow-up after colonoscopy and polypectomy, including the following:

• More detailed recommendations for follow-up after removal of serrated polyps
• Strengthened polyp surveillance recommendations that are derived from new evidence based on the risk of colorectal cancer outcomes, not evidence based only on the risk of advanced adenoma during surveillance
• An emphasis on the importance of a high-quality baseline examination

Some of the updated recommendations supported by strong evidence include the following:

• For patients with normal, high-quality colonoscopy, repeat CRC screening in 10 years.
• Repeat colonoscopy every 7 to 10 years rather than every 5 to 10 years after removing 1 or 2 tubular adenomas less than 10 mm.
• Repeat colonoscopy in 3 years after removing 5 to 10 adenomas less than 10 mm.
• Repeat colonoscopy in 3 years after removing 1 or more adenomas 10 mm or larger. 
• Repeat colonoscopy in 6 months for patients with piecemeal resection of adenoma or sessile serrated polyp greater than 20 mm.

“CRC incidence and mortality are decreasing secondary to improvements in risk factor exposures, screening, treatment, and perhaps exposure to surveillance among patients with polyps,” the authors concluded. “Given that some patients with polyps appear to have persistently increased risk for CRC, and many have increased risk for advanced neoplasia on follow-up, surveillance colonoscopy to attempt to reduce CRC risk is clinically rational and recommended.”

—Colleen Murphy

Reference:

Gupta S, Liberman D, Anderson JC, et al; US Multi-Society Task Force on Colorectal Cancer. Recommendations for follow-up after colonoscopy and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer [published online February 7, 2020]. Gastroenterology. doi:10.1053/j.gastro.2019.10.026.